CROSS-REFERENCE TO RELATED APPLICATION
BACKGROUND
1. Technical Description
[0002] The present disclosure is directed to a closure device for closing incisions, and
more particularly, to a closure device for closing port site incisions after minimally
invasive surgical procedures.
2. Background of Related Art
[0003] Minimally invasive surgical procedures including laparoscopic, endoscopic, and arthroscopic
surgical procedures are performed through small incisions, or cannulas positioned
through small incisions, in a body wall of a patient. These procedures impose less
risk of infection and result in shortened hospital stays as compared to traditional
open surgical procedures. After a minimally invasive surgical procedure is completed,
port site incisions provided to access a surgical site must be closed or sutured.
Current methods of closing port site incisions after minimally invasive surgical procedures
are highly skill dependent and typically involve directing a curved needle through
a small port and through fascial and muscular layers of tissue while attempting to
avoid contact with internal body organs. This can be especially difficult after a
laparoscopic procedure in the abdominal cavity.
[0004] A continuing need exists in the surgical arts for an improved closure device for
sealing or closing a port site incision that is simple in construction and easy to
use.
SUMMARY
[0005] One aspect of the disclosure is directed to a closure device for closing a port site
incision that includes an access device and a suture needle. The access device includes
a body defining a cutout and a head defining a slot. The body has a proximal portion
and a distal portion and defines a channel that extends between the proximal and distal
portions. The head is supported on the proximal portion of the body. The suture needle
includes a shaft and a curved portion. The shaft has a proximal portion and a distal
portion. The curved portion extends from the distal portion of the shaft and has a
tip configured to penetrate tissue that extends in a direction towards the head of
the access device. The proximal portion of the shaft extends through and is movable
within the slot in the head to move the curved portion of the suture needle from an
inactive position located within the channel to an active position located externally
of the channel.
[0006] In embodiments, the suture needle has a J-shaped configuration.
[0007] In some embodiments, an actuator knob is secured to the shaft of the suture needle.
[0008] In certain embodiments, the actuator knob is slidably supported on the head of the
access device and is movable to move the suture needle between the inactive position
and the active position.
[0009] In embodiments, the tip of the suture needle extends in a direction towards the head
of the access device.
[0010] In some embodiments, a suture is secured to the suture needle.
[0011] In certain embodiments, the suture needle includes an eyelet and the suture extends
through the eyelet to couple the suture to the suture needle.
[0012] In embodiments, the head of the access device has a first diameter and the body of
the access device has a second diameter, wherein the first diameter is greater than
the second diameter.
[0013] In some embodiments, the head of the access device defines a suture hole and the
suture extends from the eyelet of the suture needle through the suture hole.
[0014] In embodiments, the cutout in the body of the access device defines a vertical slot
that is dimensioned to facilitate passage of the curved portion of the suture needle
from within the channel into a body cavity.
[0015] In embodiments, the distal portion of the body of the access device includes a tapered
end that is configured to facilitate passage of the body of the access device through
the port site incision.
[0016] Another aspect of the disclosure is directed to a method for closing a port site
incision in a body wall. The method includes inserting a body of an access device
of a closure device through the port site incision in the body wall into a body cavity
such that a head of the access device is positioned adjacent an outer surface of the
body wall; moving a J-shaped needle having a tip configured to penetrate tissue from
an inactive position located within a channel defined within the body of the closure
device to an active position located within the body cavity externally of the channel;
tilting the body within the incision in the body wall; withdrawing the body of the
access device to move the head of the access device away from the outer surface of
the body wall such that the tip of the J-shaped needle passes through the body wall
to position a first end of a suture secured to the J-shaped needle adjacent one side
of the incision near the outer surface of the body wall; and inserting the body of
the access device through the incision in the body wall to reposition the body of
the access device within the body cavity and reposition the head of the access device
near the outer surface of the body wall.
[0017] In embodiments, moving the J-shaped needle from the inactive position to the active
position includes sliding an actuator knob attached to a proximal portion of the J-shaped
needle in relation to the head.
[0018] In embodiments, the method includes rotating the body of the access device within
the incision to move the tip of the J-shaped needle from one side of the body to an
opposite side of the body.
[0019] In some embodiments, the method includes moving the J-shaped needle from the active
position back to the inactive position prior to rotating the body of the access device.
[0020] In embodiments, the method includes moving the J-shaped needle again from the inactive
position located within the channel defined within the body of the access device to
the active position located within the body cavity externally of the channel of the
body of the access device.
[0021] In embodiments, the method includes tilting the body again within the incision in
the body wall and withdrawing the body of the access device to move the head of the
access device away from the outer surface of the body wall such that the tip of the
J-shaped needle passes through the body wall again to position a second end of the
suture adjacent a second side of the incision on the outer surface of the body wall.
[0022] In embodiments, the method includes grasping the first and second ends of the suture
and applying tension to the suture to close the port site incision.
[0023] In embodiments, the body wall is the abdominal wall and the body cavity is the abdominal
cavity.
BRIEF DESCRIPTION OF THE DRAWINGS
[0024] Various embodiments of the presently disclosed port site incision closure device
are described herein below with reference to the drawings, wherein:
FIG. 1 is a side perspective view of an exemplary embodiment of the presently disclosed
port site incision closure device ("closure device") with a suture needle in an inactive
position and a suture attached to the suture needle and extending from an access device
of the port site incision closure device;
FIG. 2 is a side cross-sectional view of the closure device shown in FIG. 1 positioned
through a port site incision with the suture needle in the inactive position, and
the suture attached to the suture needle and extending from the access device;
FIG. 3 is a side cross-sectional view of the closure device shown in FIG. 2 positioned
through the port site incision with the suture needle in an active position and the
suture attached to the suture needle and extending from the access device;
FIG. 4 is a side cross-sectional view of the closure device shown in FIG. 3 positioned
through the port site incision with the suture needle in an active position and the
closure device tilted and retracted to position the suture needle through tissue on
one side of the port site incision to position a first end of the suture externally
of tissue;
FIG. 5 is a side cross-sectional view of the closure device shown in FIG. 4 positioned
through the port site incision with the suture needle in an active position and the
closure device returned to a non-tilted position advanced position to withdraw the
suture needle from the tissue;
FIG. 6 is a side cross-sectional view of the closure device shown in FIG. 5 positioned
through the port site incision with the suture needle in an active position and the
closure device rotated about one hundred eighty degrees (180°);
FIG. 7 is a side cross-sectional view of the closure device shown in FIG. 6 positioned
through the port site incision with the suture needle in an active position and the
closure device tilted in an opposite direction and retracted to position the suture
needle through tissue on the other side of the port site incision to position a second
end of the suture externally of tissue;
FIG. 8 is a side cross-sectional view of the port site incision defined by the tissue
with opposite ends of the suture positioned on opposite sides of the incision; and
FIG. 9 is a side cross-sectional view of the port site incision defined by the tissue
with opposite ends of the suture positioned on opposite sides of the port site incision
and the suture tensed to close the incision.
DETAILED DESCRIPTION OF EMBODIMENTS
[0025] The presently disclosed closure device will now be described in detail with reference
to the drawings in which like reference numerals designate identical or corresponding
elements in each of the several views. However, it is to be understood that the disclosed
embodiments are merely exemplary of the disclosure and may be embodied in various
forms. Well-known functions or constructions are not described in detail to avoid
obscuring the present disclosure in unnecessary detail. Therefore, specific structural
and functional details disclosed herein are not to be interpreted as limiting, but
merely as a basis for the claims and as a representative basis for teaching one skilled
in the art to variously employ the present disclosure in virtually any appropriately
detailed structure.
[0026] In this description, the term "proximal" is used generally to refer to that portion
of the device that is closer to a clinician, while the term "distal" is used generally
to refer to that portion of the device that is farther from the clinician. In addition,
the term "endoscopic" is used generally used to refer to endoscopic, laparoscopic,
arthroscopic, and/or any other procedure conducted through small diameter incision
or cannula. Further, the term "clinician" is used generally to refer to medical personnel
including doctors, nurses, and support personnel.
[0027] FIGS. 1 and 2 illustrate an exemplary embodiment of the presently disclosed closure
device which is shown generally as closure device 10. The closure device 10 includes
an access device 12, a suture needle 14, and an actuation knob 16. The access device
12 includes a body 18 having a proximal portion 18a and a distal portion 18b, and
a head 20 supported on the proximal portion 18a of the body 18. The body 18 and the
head 20 of the access device 12 define a channel 22 (FIG. 2) that receives the suture
needle 14 for movement between an inactive position (FIG. 2) and an active position
(FIG. 3) as described in further detail below.
[0028] In embodiments, the body 18 defines a cutout or slot 24, e.g., a vertical oriented
cutout or slot, and the head 20 defines a substantially horizontal cutout or slot
26. The cutout 24 is dimensioned to facilitate passage of a distal end of the suture
needle 14 from within the channel 22 to a position externally of the channel 22. The
slot 26 is dimensioned to facilitate passage of a proximal end of the suture needle
14 from within the channel 22 to a position adjacent an outer surface of the head
20. In some embodiments, the body 18 and the head 20 of the access device 12 are cylindrical
and the head 20 has a diameter that is greater than a diameter of the body 18. The
enlarged diameter of the head 20 of the access device 12 obstructs passage of the
closure device 10 through a port site incision "P" (FIG. 2) into a body cavity "BC".
In certain embodiments, the access device 12 may be in the form of an obturator wherein
the distal portion 18b of the body 18 has a tapered end 18c to facilitate passage
of the body 18 through the port site incision "P".
[0029] The suture needle 14 includes a needle shaft 30 and a curved portion 32. The needle
shaft 30 has a proximal portion 30a and a distal portion 30b. The proximal portion
30a extends through and is movable laterally within the slot 26 in the head 20 of
the access device 12 to facilitate movement of the suture needle 12 between the inactive
position (FIG. 2) and the active position (FIG. 3) as described in further detail
below. The curved portion 32 of the suture needle 12 includes a tip 34 that is configured
to penetrate tissue. The tip 34 or a portion of the curved portion near the tip 34
defines an eyelet 35 through which a suture 36 can pass to secure the suture 36 to
the suture needle 12. In embodiments, the curved portion 32 of the suture needle 12
is substantially U-shaped and the suture needle 12 is substantially J-shaped. In some
embodiments, the tip 34 of the suture needle 12 is pointed towards the head 20 of
the access device 12 and extends in a direction parallel to a longitudinal axis "X"
(FIG. 1) of the access device 12. Alternately, other suture needle configurations
are envisioned.
[0030] In some embodiments, the head 20 of the access device 12 defines a suture hole 72
(FIG. 1). The suture 36 extends from the eyelet 35 of the suture needle 12 through
the channel 22 of the body 18 of the access device 12 and through the suture hole
72.
[0031] The actuation knob 16 is secured to the proximal portion 30a of the needle shaft
30 of the suture needle 12 and is movable in relation to the head 20 of the access
device 12 to move the suture needle 12 between the inactive position (FIG. 2) and
the active position (FIG. 3). In the inactive position, the curved portion 32 of the
suture needle 14 is positioned within the channel 22 of the body 18 of the access
device 12 such that the access device 12 can be safely inserted through the port site
incision "P" without danger of the suture needle 14 inadvertently snagging and/or
penetrating tissue. In the active position, the suture needle 14 is positioned externally
of the channel 22 of the body 18 within a body cavity "BC" such that the body 18 of
the access device 12 can be retracted or partially withdrawn from within the port
site incision "P" to suture a body wall "BW", e.g., the abdominal wall, defining the
incision "P" to close the incision "P". Because the tip 34 of the suture needle 12
is directed towards the head 20 of the access device 12 when the suture needle 12
is in the active position, the likelihood of inadvertent damage to internal organs
within a body cavity "BC", e.g., the abdominal cavity, during manipulation of the
closure device 10 is greatly reduced. Although the actuation knob 16 is shown as a
button that is secured to the proximal portion 30a of the needle shaft 30, it is envisioned
that other actuator configurations are envisioned.
[0032] FIGS. 2-9 illustrate use of the presently disclosed closure device 10 for closing
a port site incision "P" in a body wall "BW" of a patient after a minimally invasive
surgical procedure. Referring to FIGS. 2 and 3, after a minimally invasive surgical
procedure is completed, or any time it becomes necessary to close an incision "P"
in a body wall "BW" of a patient, the body 18 of the closure device 12 is inserted
through the port site incision "P" in the body wall "BW" with a suture 36 secured
to the suture needle 14 such that the distal portion 18b of the body 18 is positioned
within the body cavity "BC" and the head 20 of the access device 12 is positioned
near an outer surface 70 of the body wall "BW". After the access device 12 is properly
positioned within the incision "P", the suture needle 14 is moved from the inactive
position (FIG. 2) to the active position (FIG. 3) in the direction indicated by arrows
"A" by sliding the actuation knob 16 in relation to the head 20 of the access device
12 along the horizontal slot 26. As the suture needle 14 moves towards the active
position, the curved portion 32 of the suture needle 14 moves through the cutout 24
of the body 18 and passes from the channel 22 into the body cavity "BC". As shown,
in the active position, the tip 34 of the suture needle 12 is directed towards the
incision "P" and the head 20 of the access device 12.
[0033] Referring to FIG. 4, after the suture needle 14 is in the active position, the access
device 12 can be tilted and partially withdrawn from within the incision "P" in the
direction indicated by arrows "B" to move the head 20 of the access device 12 away
from the outer surface 70 of the body wall "BW" such that the tip 34 of the suture
needle 14 passes through the body wall "BW" to position a first end 36a of the suture
36 adjacent one side of the incision "P" near the outer surface 70 of the body wall
"BW". When the first end 36a of the suture 36 is accessible to a clinician, the clinician
grasps and holds the first end 36a of the suture 36.
[0034] Referring to FIG. 5, after the clinician has a firm grasp on the first end 36a of
the suture 36, the access device 12 is further inserted through the incision "P" in
the body wall "BW" to reposition the body 18 within the body cavity "BC" and reposition
the head 20 of the access device 12 adjacent or nearer to the outer surface 70 of
the body wall "BW".
[0035] Referring to FIG. 6, after the body 18 of the access device 12 is repositioned within
the body cavity "BC", the access device 12 can be rotated in the direction indicated
by arrows "C" within the incision "P" to reposition the tip 34 of the suture needle
14 beneath an opposite side of the incision "P". Although not shown, it is envisioned
that prior to rotating the access device 12, the suture needle 14 can be returned
to its inactive position by once again moving the actuation button 16 along the slot
26 to move the suture needle 14 back into the channel 22 of the body 18 of the access
device 12. In either method of use, the suture needle 12 should be moved to the active
position (FIG. 6) after the access device 12 is rotated to the position shown in FIG.
6.
[0036] Referring to FIG. 7, after the access device 12 is rotated to the position shown
in FIG. 6, the access device 12 can be tilted in an opposite direction and partially
withdrawn from within the incision "P" in the direction indicated by arrows "D" to
move the head 20 of the access device 12 away from the outer surface 70 of the body
wall "BW" such that the tip 34 of the suture needle 12 passes through the body wall
"BW" adjacent an opposite side of the incision "P" to position a second end 36b of
the suture 36 adjacent the other side of the incision "P" near the outer surface 70
of the body wall "BW". When the second end 36b of the suture 36 is accessible to a
clinician, the clinician grasps and holds the second end of the suture 36.
[0037] Referring to FIGS. 8 and 9, after the clinician has a grasp on both ends 36a, 36b
of the suture 36, the closure device 10 can be withdrawn from the incision "P" and
properly disposed of in a customary manner. Thereafter, the clinician can apply tension
to the ends 36a, 36b of the suture in the direction indicated by arrows "E" to close
the incision "P".
[0038] Persons skilled in the art will understand that the devices and methods specifically
described herein and illustrated in the accompanying drawings are non-limiting exemplary
embodiments. It is envisioned that the elements and features illustrated or described
in connection with one exemplary embodiment may be combined with the elements and
features of another without departing from the scope of the present disclosure. As
well, one skilled in the art will appreciate further features and advantages of the
disclosure based on the above-described embodiments. Accordingly, the disclosure is
not to be limited by what has been particularly shown and described, except as indicated
by the appended claims.
[0039] The invention may be described by reference to the following numbered paragraphs:-
- 1. A closure device for closing a port site incision, the closure device comprising:
an access device including a body defining a cutout and a head defining a slot, the
body having a proximal portion and a distal portion and defining a channel that extends
between the proximal and distal portions, the head being supported on the proximal
portion of the body; and
a suture needle including a shaft and a curved portion, the shaft having a proximal
portion and a distal portion, the curved portion extending from the distal portion
of the shaft and having a tip configured to penetrate tissue, the tip extending in
a direction towards the head of the access device, wherein the proximal portion of
the shaft extends through and is movable within the slot in the head to move the curved
portion of the suture needle from an inactive position located within the channel
to an active position positioned located externally of the channel.
- 2. The closure device of paragraph 1, wherein the suture needle has a J-shaped configuration.
- 3. The closure device of paragraph 1, further including an actuator knob secured to
the shaft of the suture needle.
- 4. The closure device of paragraph 3, wherein the actuator knob is slidably supported
on the head of the access device and is movable to move the suture needle between
the inactive position and the active position.
- 5. The closure device of paragraph 2, wherein the tip of the suture needle extends
towards the head of the access device.
- 6. The closure device of paragraph 5, further including a suture secured to the suture
needle.
- 7. The closure device of paragraph 6, wherein the suture needle includes an eye, the
suture extending through the eye to couple the suture to the suture needle.
- 8. The closure device of paragraph 1, wherein the head of the access device has a
first diameter and the body of the access device has a second diameter, the first
diameter being greater than the second diameter.
- 9. The closure device of paragraph 7, wherein the head of the access device defines
a suture hole, the suture extending from the eye of the suture needle through the
suture hole.
- 10. The closure device of paragraph 1, wherein the cutout in the body of the access
device defines a vertical slot that is dimensioned to facilitate passage of the curved
portion of the suture needle from within the channel into a body cavity.
- 11. The closure device of paragraph 1, wherein the distal portion of the body of the
access device includes a tapered end, the tapered end facilitating passage of the
body of the access device through the port site incision.
1. A closure device for closing a port site incision, the closure device comprising:
an access device including a body defining a cutout and a head defining a slot, the
body having a proximal portion and a distal portion and defining a channel that extends
between the proximal and distal portions, the head being supported on the proximal
portion of the body; and
a suture needle including a shaft and a curved portion, the shaft having a proximal
portion and a distal portion, the curved portion extending from the distal portion
of the shaft and having a tip configured to penetrate tissue, the tip extending in
a direction towards the head of the access device, wherein the proximal portion of
the shaft extends through and is movable within the slot in the head to move the curved
portion of the suture needle from an inactive position located within the channel
to an active position positioned located externally of the channel.
2. The closure device of claim 1, wherein the suture needle has a J-shaped configuration.
3. The closure device of claim 1 or claim 2, further including an actuator knob secured
to the shaft of the suture needle.
4. The closure device of claim 3, wherein the actuator knob is slidably supported on
the head of the access device and is movable to move the suture needle between the
inactive position and the active position.
5. The closure device of claim 2, wherein the tip of the suture needle extends towards
the head of the access device.
6. The closure device of claim 5, further including a suture secured to the suture needle.
7. The closure device of claim 6, wherein the suture needle includes an eye, the suture
extending through the eye to couple the suture to the suture needle.
8. The closure device of any preceding claim, wherein the head of the access device has
a first diameter and the body of the access device has a second diameter, the first
diameter being greater than the second diameter.
9. The closure device of claim 7, wherein the head of the access device defines a suture
hole, the suture extending from the eye of the suture needle through the suture hole.
10. The closure device of any preceding claim, wherein the cutout in the body of the access
device defines a vertical slot that is dimensioned to facilitate passage of the curved
portion of the suture needle from within the channel into a body cavity.
11. The closure device of any preceding claim, wherein the distal portion of the body
of the access device includes a tapered end, the tapered end facilitating passage
of the body of the access device through the port site incision.